Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity A Randomized Clinical Trial
Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity A Randomized Clinical Trial
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DOI：
10.1001/jamapediatrics.2017.4938
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发表时间：
2018-03-01
期刊：
影响因子：
26.1
通讯作者：
McConnochie, Kenneth M.
中科院分区：
文献类型：
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作者：
Halterman, Jill S.;Fagnano, Maria;McConnochie, Kenneth M.
对推荐的预防性哮喘药物依从性差是常见的，导致可预防的发病率。我们开发了校本远程医疗哮喘病强化管理（SB-TEAM）项目，在校本监督治疗项目的基础上，结合学校远程医疗，克服预防哮喘病护理的障碍。目的评价SB-TEAM项目对城市持续性哮喘患儿哮喘发病率的影响。设计,设置。在这项随机临床试验中，纽约州罗彻斯特市学区3至10岁的持续性哮喘儿童根据基线预防性药物使用情况进行分层，并随机分配到SB-TEAM项目或强化常规护理1学年。参与者在学年（2012-2016）开始时注册，并在学年结束时评估结果。2017年5月至2017年11月的数据分析采用多变量修正意向治疗分析。干预措施：监督学校预防性哮喘药物的管理以及3次校本远程医疗访问，以确保适当的评估、预防性药物处方和随访护理。远程医疗访问的学校现场部分由远程医疗助理完成，远程医疗助理获取病史和检查数据。这些数据存储在一个安全的虚拟等候室中，然后由初级保健临床医生查看，他们完成评估并通过视频会议或电话与护理人员沟通。预防性药物处方被送到药房，由药房送到学校，在监督下进行日常用药。主要结局和测量主要结局是每2周无症状的平均天数，通过每两个月的盲法访谈进行评估。结果400名入组儿童中，247名（61.8%）为男性，230名（57.5%）为非裔美国人，平均（SD）年龄为7.8（1.7）岁。两组的人口统计学特征和哮喘严重程度在基线时相似。在SB-TEAM组的儿童中，196名（98.0%）进行了一次或多次远程医疗访问，165名（82.5%）通过学校接受了监督治疗。我们发现，与强化常规护理组相比，SB-TEAM组儿童干预后每2周无症状天数更多（11.6 vs 10.97；差异为0.69;95% CI, 0.15-122; P = 0.01），在最后随访时观察到最大差异（差异为0.85;95% CI, 0.10-1.59）。此外，SB-TEAM组儿童因哮喘就诊或住院的可能性较低（7% vs 15%；优势比为0.52；95% CI为0.32-0.84）。结论与意义SB-TEAM干预显著改善了城市持续性哮喘儿童的症状，降低了医疗保健使用率。这个项目可以作为学龄儿童哮喘可持续护理的典范。
IMPORTANCE Poor adherence to recommended preventive asthma medications is common, leading to preventable morbidity. We developed the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) program to build on school-based supervised therapy programs by incorporating telemedicine at school to overcome barriers to preventive asthma care.OBJECTIVE To evaluate the effect of the SB-TEAM program on asthma morbidity among urban children with persistent asthma.DESIGN, SETTING. AND PARTICIPANTS In this randomized clinical trial, children with persistent asthma aged 3 to 10 years in the Rochester City School District in Rochester, New York, were stratified by preventive medication use at baseline and randomly assigned to the SB-TEAM program or enhanced usual care for 1 school year. Participants were enrolled at the beginning of the school year (2012-2016), and outcomes were assessed through the end of the school year. Data were analyzed between May 2017 and November 2017 using multivariable modified intention-to-treat analyses.INTERVENTIONS Supervised administration of preventive asthma medication at school as well as 3 school-based telemedicine visits to ensure appropriate assessment, preventive medication prescription, and follow-up care. The school site component of the telemedicine visit was completed by telemedicine assistants, who obtained history and examination data. These data were stored in a secure virtual waiting room and then viewed by the primary care clinician, who completed the assessment and communicated with caregivers via videoconference or telephone. Preventive medication prescriptions were sent to pharmacies that deliver to schools for supervised daily administration.MAIN OUTCOMES AND MEASURES The primary outcome was the mean number of symptom-free days per 2 weeks, assessed by bimonthly blinded interviews.RESULTS Of the 400 enrolled children, 247 (61.8%) were male and 230 (57.5%) were African American, and the mean (SD) age was 7.8 (1.7) years. Demographic characteristics and asthma severity in the 2 groups were similar at baseline. Among children in the SB-TEAM group, 196 (98.0%) had 1 or more telemedicine visits, and 165 (82.5%) received supervised therapy through school. We found that children in the SB-TEAM group had more symptom-free days per 2 weeks postintervention compared with children in the enhanced usual care group (11.6 vs 10.97; difference, 0.69; 95% CI, 0.15-122; P = .01), with the largest difference observed at the final follow-up (difference, 0.85; 95% CI, 0.10-1.59). In addition, children in the SB-TEAM group were less likely to have an emergency department visit or hospitalization for asthma (7% vs 15%; odds ratio, 0.52; 95% CI, 0.32-0.84).CONCLUSIONS AND RELEVANCE The SB-TEAM intervention significantly improved symptoms and reduced health care utilization among urban children with persistent asthma. This program could serve as a model for sustainable asthma care among school-aged children.